The landscape of Nepal is a geographical staircase, descending from snow-capped Himalayan mountains, through steep middle hills, to the lush flat plains of the south. This is the location for the latest BBC Our World: Banished for Bleeding.
In the middle step, in the remote far west of the country, life has changed little over the decades.
For 18-year-old Ishwari Joshi, this means doing as her mother and grandmother did before her and leaving her home when she has her period.
The practice is called “chhaupadi” - a name for menstruation which also conveys the meaning that a woman is unclean when she is bleeding.
“The first time I had my period I was 15. I had to stay out for nine days,” she says. "We have to sleep outside."
Ishwari's village Dhamilekh clings to an exposed hillside, commanding breathtaking views of high mountains and a low green valley criss-crossed by two rivers.
About 100 families live here, snugly squeezed together in three-storey, mud-plastered houses. Cattle sleep on the ground floor, families on the middle, while the top floor is used for cooking.
When a woman starts her period, she has to leave this warmth for the seclusion of a specially built hut. These are tiny spaces, shared by several families, without proper beds or bedding.
When the women are isolated here, they can't cook, eat nutritious food, drink from or bathe in the village water source. They are forbidden from touching plants, cattle or men.
“It is said that if we touch a cow, they will not give milk,” says Ishwari's friend Nirmala. “We've never seen anything like that happen, but our elders say we must not touch the cows.”
Kalpana Joshi, 45, is resigned to her monthly stays in her “chhau” hut, a room little bigger than a crawl space beneath her village shop. “Nothing will happen,” she says, reassuring the younger women who fear attacks by animals and drunk men.
A few metres away is the village toilet Kalpana helped build as part of a government drive to stop open defecation. It's out of bounds to her because it's believed she will pollute the water supply.
“We're not allowed to touch the toilet because it's the same water we use at home,” she says. “We have to go to the fields far away from the house where nobody can see us.”
After four days in the hut, the village women bathe in a stream an hour's walk away and are “purified” with cow urine. Only then can they return to normal life.
They say chhaupadi is not enforced as strictly as it used to be, telling stories of mothers and grandmothers who were exiled during their monthly bleed. But even this more relaxed interpretation of chhaupadi is too much for some.
“I told my parents, 'I won't go, why should I?',” says 22-year-old Laxmi. “My parents got angry, but my brothers understood so they don't mind if I stay at their house,” she says.
Laxmi knows her protest is unlikely to continue when she marries and moves into her husband's household, as is the tradition in Nepal.
“If the family insists I have to sleep outside, I will have no choice,” she says. “I will be forced to do it.”
Breaking down the huts
There has been another drive to end chhaupadi. Over the past two years, the local government and NGOs have helped organise a campaign to tear down the huts in the village of Majhigaun.
Devaki Joshi owns the local shop and was part of the organising committee.
“In the old days, people didn't shower or wash their clothes so it was more unhygienic during periods - perhaps this is why chhaupadi began,” she says. “But now at school they have a cupboard with sanitary towels for students.”
But not everyone has accepted the change.
A few houses down from Devaki's shop, Chiutari Sunar sits outside with her mother-in-law.
“We still follow the same practices,” she says pointing to the space beneath the house where the buffalo are kept.
It's her new chhaupadi sleeping spot now her old hut has been demolished.
“In our house, when we are menstruating, we can't go inside at any cost, no matter what the government says. This is even more important to me than going to the temple.”
Even Devaki, who is enthusiastic about the success of her project, admits that some people may never accept the change.
“We don't want to hurt the feelings of the older people like my mother,” she says. “We still don't touch them when we have our period.”
Lila Ghale, the local head of the government department for women and children, says it may take another generation before chhaupadi is fully eliminated.
“We are working with everyone - men, women and even witch-doctors,” she says. “Our culture is patriarchal and many women are illiterate which makes it hard to change things.”
And, says health worker Pema Lakhi, changing attitudes is not just about telling people chhaupadi is bad.
She wants Nepali girls to celebrate their monthly bleed.
“Who says it is impure? It gives life. We tell women there is power in their periods,” she says.
“We tell them there's power in your blood.”
(Our World: Banished for Bleeding will air on BBC World News on Friday May 5 at 3pm.)
Also read: Even goddess in temple bleeds like all women. It's a blessing, not filth